WO2007119212A2 - A surgical access device - Google Patents

Abstract

A surgical access device in the form of an introducer for use in gynaecological procedures, which can be inserted into a patient's body. The device (10) includes a semi-rigid main tube (28) in which an endoscope can be received and a secondary tube (30) in which a surgical instrument in the form of a grasper (20) can be received. The main tube (28) is surrounded by a sheath (34). The secondary tube (30) is in the form of a collapsible membrane which is secured to the sheath (34). The membrane is radially flexible and is deployed into a dilated condition when the grasper (20) is introduced into the membrane. When inserting the grasper (20) into the tube (30), the guide plates (46.1) and (46.2) guide the grasper between the guide plates so as to prevent the grasper from moving off-centre to one side of the main tube (28).

Description

A SURGICAL ACCESS DEVICE

FIELD OF INVENTION

This invention relates to a surgical access device for use in performing endoscopic surgery through a bodily orifice such as a cervix, vagina, rectum, etc.

BACKGROUND TO THE INVENTION

Surgical access devices of a type having a semi-rigid main tube through which an endoscope can be inserted and an auxiliary tube having a radially flexible wall, for the insertion of endoscopic surgical instruments, are known. Such a surgical access device is disclosed in US Patent 5,772,628. A disadvantage of the surgical access device disclosed in US Patent 5,772,628 is that when inserting an endoscopic surgical instrument into the auxiliary tube, the tube deforms significantly so that the endoscopic surgical instrument is able to move off-centre to one side of the main tube, in use.

It is an object of the present invention to ameliorate the abovementioned problem associated with the surgical access device disclosed in US Patent 5,772,628. SUMMARY OF THE INVENTION

According to the invention there is provided a surgical access device including:

a semi-rigid first tube defining a first passage through which an endoscope can be inserted into the body of a patient;

a second tube which is located adjacent the first tube and which has a radially flexible wall having a collapsed condition wherein the second tube closely conforms to an outer surface of the first tube and a dilated condition wherein the second tube is expanded from its collapsed condition so as to provide a second passage through which an endoscopic surgical instrument can be inserted into the body of the patient; and

auxiliary guide means which is configured to prevent lateral displacement of an endoscopic instrument which is located in the second passage of the second tube, in use.

The surgical device may have a proximal end and a distal end, with the first and second tubes extending substantially between the proximal and distal ends.

The auxiliary guide means may be located approximate to the distal end of the surgical access device.

The auxiliary guide means may be in the form of a rigid guide member which extends outwardly from the first tube. More particularly, the guide member may comprise a pair of spaced lateral guide plates which define a guide channel between them within which the endoscopic surgical instrument is slideably displaceable, in use.

Each of the guide plates may define a tapered profile wherein the guide plate tapers towards the distal end of the surgical access device. BRIEF DESCRIPTION OF THE DRAWINGS

Further features of the invention are described herein after by way of a non- limiting example of the invention, with reference to and as illustrated in the accompanying diagrammatic drawings. In the drawings:

Figure 1 shows a schematic side elevation of a surgical access device in accordance with the invention illustrating a partially inserted endoscope and a secondary instrument in a pre-introduction position;

Figure 2 shows an enlarged schematic side elevation of the distal tip of the surgical access device of Figure 1 , showing the secondary tube thereof in a collapsed condition;

Figure 3 shows an enlarged schematic perspective view of the distal tip of the surgical access device of Figure 1 showing the secondary tube thereof in a collapsed condition;

Figure 4 shows a schematic cross-sectional view of the surgical access of Figure 1 , sectioned along section line IV-IV of Figure 2;

Figure 5 shows a schematic perspective view of the surgical access device of Figure 1 , showing the secondary tube in a dilated condition; and

Figure 6 shows a schematic cross-sectional view of the surgical access device of Figure 1 , sectioned along section line Vl-Vl of Figure 5.

DESCRIPTION OF THE PREFERRED EMBODIMENTS

With reference to the drawings, a surgical access device in accordance with the invention is designated generally by the reference numeral 10. In this instance, the surgical access device 10 is in the form of an introducer for use in gynaecological procedures. The surgical access device 10 comprises a distal insertion portion 12 which is intended for insertion into a patient's body and a proximal housing portion 14 which generally remains outside the patient's body. Access to the patient's body is achieved via the cervix of the patient.

In Figure 1 of the drawings, an endoscope 16 is shown partially inserted into a main port 18 formed at the proximal end of the surgical access device 10. A secondary instrument in the form of a grasper 20 is shown in a position prior to insertion into a secondary port 22 also at a proximal end of the surgical access device. The housing 16 includes an inflow conduit 24 which is connected to the main port 18 and an outflow conduit 26 which is connected to the secondary port 22.

The surgical access device 10 includes a semi-rigid main tube 28 which is connected to the main port 18 and a secondary tube 30 which is connected to the secondary port 22 and which is mounted to an exterior surface of the main tube. The main tube 28 defines a passage 32 through which the endoscope 16 can be inserted into the body of a patient. The main tube 28 is surrounded by a larger diameter split sheath 34. The split in the sheath 34 defines a longitudinal slit 36. A membrane 38 which forms the secondary tube 30 is sandwiched between the inner main tube 28 and the outer split sheath 34. The membrane 38 thus surrounds the inner main tube 28 but, due to its greater diameter extends out of the longitudinal slit 36 in the split sheath 34. The excess membrane material is folded back onto the outer surface of the split sheath 34 so as to form a double layer of the membrane along a partial circumference of the split sheath in a collapsed condition of the secondary tube. Folded back portions of the secondary tube 30 form pleats 42 in the collapsed condition of the secondary tube.

The membrane 38 is radially flexible and is deployed into a dilated condition from the collapsed condition thereof when the grasper 20 is introduced into the secondary port 22. In use, as the grasper 20 is inserted into the secondary tube 30, the secondary tube opens up so as to define a second passage 44 in which the grasper is received. In this arrangement, the grasper 20 almost completely occupies the second passage 44. The surgical access device further includes auxiliary guide means comprising a pair of spaced lateral guide plates 46.1 and 46.2 which are mounted to and which extend upwardly from a distal tip 45 of the main tube 28 so as to define a guide channel 48 between them. Each of the guide plates 46.1 and 46.2 defines a tapered profile wherein the guide plates taper towards the distal end of the surgical access device. At its widest end, each plate projects outwardly from the main tube 28 a distance of three millimeters.

In use, when inserting the grasper 20 or any other endoscopic surgical instrument into the secondary tube 30, the guide plate 46.1 and 46.2 guide the tip region of the surgical instrument between the guide plates preventing the surgical instrument from moving off-centre to one side of the main tube 28 as is the case with the surgical access device disclosed in US Patent 5,772,628 wherein the auxiliary tube deforms significantly near its distal end.

The Applicant has found that when using the surgical access device disclosed in US Patent 5,772,628, lateral off-centre movement of an endoscopic surgical instrument located within the auxiliary tube thereof, makes it particularly difficult to perform a surgical procedure such as a biopsy, as the endoscope which carries the lens will be out of alignment with the endoscopic surgical instrument. As such, when using the surgical access device disclosed in US Patent 5,772,628, it is necessary to manipulate an endoscopic surgical instrument located in the auxiliary tube to bring it into alignment with an endoscope located in the main tube. In contrast thereto, when using the surgical access device in accordance with the present invention, an endoscopic surgical instrument located in the secondary tube thereof is held in place by the guide plates in alignment with an endoscope located within the first tube of the surgical access device.

The surgical access device 10 in accordance with the invention and more particularly the guide plates 46.1 and 46.2, thus ameliorate the abovementioned problem associated with the surgical device disclosed in US Patent 5,772,628.

Claims

1. A surgical access device including:

a semi-rigid first tube defining a first passage through which an endoscope can be inserted into the body of a patient;

a second tube which is located adjacent the first tube and which has a radially flexible wall having a collapsed condition wherein the second tube closely conforms to an outer surface of the first tube and a dilated condition wherein the second tube is expanded from its collapsed condition so as to provide a second passage through which an endoscopic surgical instrument can be inserted into the body of the patient; and

auxiliary guide means which is configured to prevent lateral displacement of an endoscopic instrument which is located in the second passage of the second tube, in use.

2. The surgical access device as claimed in claim 1 , which has a proximal end and a distal end, with the first and second tubes extending substantially between the proximal and distal ends.

3. The surgical access device as claimed in claim 2, wherein the auxiliary guide means is located proximate the distal end of the surgical access device.

4. The surgical access device as claimed in claim 3, wherein the auxiliary guide means is in the form of a rigid guide member which extends outwardly from the first tube.

5. The surgical access device as claimed in claim 4, wherein the guide member comprises a pair of spaced lateral guide plates which define a guide channel between them within which the endoscopic surgical instrument is slideably displaceable, in use.

6. The surgical access device as claimed in claim 5, wherein each of the guide plates defines a tapered profile wherein the guide plate tapers toward the distal end of the surgical access device.